May 8, 2001

Rules Published for VA's Diabetes-Agent Orange Benefits

WASHINGTON -- Vietnam veterans with "Type 2" diabetes came closer
today to receiving disability compensation from the Department of Veterans
Affairs (VA) with the formal publication of the rules that will allow VA to
provide benefits to those veterans.

"The hazards of the battlefield include more than bullets and
shells," said Secretary of Veterans Affairs Anthony J. Principi. "As
our understanding of the health risks faced by our military personnel
increases, VA will adjust its programs and benefits to fit the needs of
veterans."

Principi's announcement came as the Federal Register today published
VA's final rules for benefits for Vietnam veterans with "Type 2"
diabetes. Under federal law, those rules don't take effect for 60 days.
However, VA offices are already accepting claims from eligible Vietnam
veterans.

Veterans affected by the new rules will receive a priority for VA health care,
and, depending upon the severity of their illnesses, disability compensation
that ranges from $101 to $2,107 monthly.

Today's announcement follows a report in November by the National Academy of
Sciences' prestigious Institute of Medicine (IOM) that found "limited /
suggestive" evidence of a link between adult-onset, or Type 2, diabetes,
and Agent Orange and other herbicides used in Vietnam.

VA estimates that about 9 percent of the 2.3 million Vietnam veterans still
alive have Type 2 diabetes. The illness is characterized by high blood sugar
levels caused by the body's inability to process the hormone insulin.
Approximately 16 percent of veterans currently receiving care in VA medical
facilities have been diagnosed with diabetes.

Cost of the new benefit during the next five years is projected to
be $3.3 billion, with about 220,000 veterans receiving benefits.

The number of diseases recognized by VA
as associated with Agent
Orange has steadily increased
since the early 1990s.

VA and Diabetes

Background

Diabetes Mellitus is a serious
national problem that has reached epidemic proportions. Nearly 16 million
Americans (5.9 percent) have diabetes but about 5.5 million Americans are
undiagnosed, based upon data from the Centers for Disease Control and
Prevention. VA’s patients with diabetes account for about 16 percent of the
total it cares for. That number is based upon a combination of physician coding
and prescriptions for diabetes medications.

With the objective of
standardizing diabetes care by clinicians, VA distributed treatment guidelines
for veterans with diabetes in March 1997. These guidelines were developed by
more than 70 scientists and clinicians from VA and other federal agencies, many
of whom hold leadership positions in the American Diabetes Association (ADA)
and the National Diabetes Education Program. They were revised in partnership
with the Department of Defense in February 2000.

Data Base

In 1994, VA initiated a diabetes
database with voluntary participation by VA facilities. The information
documents the prevalence, costs and complications of diabetes. It also
demonstrates links between intermediate health outcomes -- such as blood sugar,
hypertension and cholesterol -- and medication usage.

Since 1999, the database has
included a census of all VA diabetic patients. Based on the information
available, VA’s Healthcare Analysis and Information Group has made meeting
presentations and published numerous reports and journal articles. VA publishes
annual reports on demographics, use of pharmaceuticals and intermediate health
outcomes and complications, specifically lower-extremity amputations.

Performance Measures

In 1996, VA established
performance measures, which are updated yearly, to evaluate the quality of care
given for diabetes. The VA Office of Quality and Performance uses these
measures to document the rates of screening for eye, kidney and foot problems
and the rates of testing for and lowering blood sugar values and "bad cholesterol"
(low density lipoprotein cholesterol or LDL-C).

The latest data show that 93
percent of veterans with diabetes receive an annual HbA1c test for blood sugar.
Of this group, 15 percent are above the 9.5 percent level, which is poor
control, and 63 percent are below eight percent, the target value the ADA
recommends for intervention. Over 75 percent of veterans with diabetes
receiving cholesterol testing have "bad" cholesterol lower than the
target of 130 mg/dl.

An annual foot exam was
performed on 93 percent of VA’s most recently tracked diabetic patients. An
annual retinal exam was given to 67 percent, even though patients with
target-level HbA1c levels not receiving insulin only require biennial eye
exams. And 54 percent of diabetic patients had lab tests for renal status.

Partnerships

In addition to multiple
investigator research studies, VA has partnered with the Juvenile Diabetes
Foundation to establish six VA Diabetes Research Centers of Excellence. VA
signed an agreement with the ADA in March 1998 to collaborate in such areas as
education and quality of care.

VA has established the Diabetes
Quality Enhancement Research Initiative (QUERI) to translate research findings
into better care for patients with diabetes. In 2000,VA funded a
five-year, multi-site study to determine if tight control of blood sugar will
decrease the

number of macrovascular
complications, such as heart disease and stroke, that are the major cause of
hospitalization and death for persons with diabetes.

Two of the last three presidents
of the ADA Health Care and Education Track have been VA clinicians nationally
recognized in the fields of podiatry and patient education. The ADA journal Diabetes
Care will publish a special supplement on diabetes care in VA in the next
few months. VA accomplishments in diabetes quality of care were presented in a
plenary session at the ADA June 2000 national scientific sessions.

In March 1999 and May 2000, VA hosted national symposiums to
enhance the education of VA clinicians about diagnosis and treatment of
patients with diabetes.

VA will continue to expand its
partnerships and implementation of its diabetes projects. VA participates in
several federally led coalitions, including the National Diabetes Education
Program, the Diabetes Quality Improvement Project and the Diabetes Mellitus
Interagency Coordinating Committee

TYPE 2 DIABETES

Type
2 diabetes is the most common form of diabetes. Type 2 diabetes happens when
your body either cannot produce enough insulin or does not use the insulin it
makes properly – insulin is a hormone produced by the pancreas.

Many
of the foods we eat – such as bread, potatoes, rice, pasta, milk and fruit –
are converted into sugar and give us the energy we need to maintain life.
Insulin gets the sugar into the cells, but if you have type 2 diabetes, your
body can’t do that without help.

Finding
out you have diabetes is scary. Type 2 diabetes is serious, but people with
diabetes can live long, healthy, happy lives.

While
diabetes occurs in people of all ages and races, some groups have a higher risk
for developing type 2 diabetes than others. Type 2 diabetes is more common in
Vietnam Veterans (due to exposure to Agent Orange), African Americans, Latinos,
Native Americans, and Asian Americans/Pacific Islanders, as well as the aged
population.

How did I get diabetes?There
is no single cause of type 2 diabetes, but some factors put people at a greater
risk, including:

Being
age 40 or over

Being
overweight

Having
a family member who has diabetes

Having
had gestational diabetes (diabetes during pregnancy)

Exposure
to Agent Orange

Complications of diabetesDiabetes
is a life-long condition. High blood glucose levels over a long period of time
can cause blindness, heart disease, kidney problems, amputations, nerve damage
and erectile dysfunction. Good diabetes care and management can prevent or delay
the onset of these complications.
When you have your regular check-up, ask your doctor to check for
complications.
Make sure that you are referred to the appropriate specialist, if required.

Vietnam Veterans please see a local service officer (DAV, VFW,
etc) and file a disability claim.